Children's Alliance response to GraniteCare
Medicaid proposal
Why replace a successful Healthy Kids program with an untested
scheme in which children will suffer?
January 3, 2005
John A. Stephen
Commissioner
Department of Health and Human Services
129 Pleasant Street
Concord, NH 03301
Dear Commissioner Stephen:
Thank you for the opportunity to provide feedback on your GraniteCare
plan. We appreciate your presence at the recent public forums and look
forward to an increasingly transparent process.
We have several concerns about GraniteCare' s proposed use of Health
Services Accounts (HSA) to provide health coverage for poor children
and pregnant women. Our concerns range from the general — whether there
is a true need for such drastic change in the delivery of children’s
Medicaid and SCHIP services — to more specific concerns about
program implementation.
We begin with our overarching concern about the proposed use of HSAs.
We recognize that HSAs are a priority of the Bush Administration, but
New Hampshire is the wrong place — and poor children and women the wrong
populations — for this concept.
Services to children are not a significant driver of Medicaid spending
In New Hampshire. While children comprise little more than one-half
of New Hampshire's Medicaid recipients, they account for just over 20%
of the costs. They are by far the program's lowest-cost recipients.
Before this plan moves forward, The Department should produce data
showing where and how children and pregnant women at and over 133% of
the federal poverty level are misusing services and wasting Medicaid
dollars.
Such data is especially important in light of the proven track record
of our existing child health insurance program. New Hampshire's successful
Healthy Kids health insurance program was recently praised as a national
model by U.S. Senate Majority Leader Bill Frist. Healthy Kids now covers
approximately 15,000 Medicaid eligible children and 6,500 SCHIP eligible
children. Instead of turning away from this success story, we should
build on it — with an increased effort to reach the 17,000 children
who remain uninsured. Efforts should focus on outreach and increased
provider reimbursement.
Moreover, even if New Hampshire were to consider changes to its Healthy
Kids program, it should not adopt an HSA model. HSAs are inappropriate
for low-income families with children.
While we applaud proposed incentives for access to preventive care
(as well as provider incentives for alcohol and tobacco addiction screening
and treatment), we are concerned by the next level of HSA coverage which
rewards families who don't spend all of their non-emergency account
— thus creating an incentive to forego routine health care for their
children. These parents will be faced with the choice of seeking treatment
for a child with a possible ear or throat infection or receiving a voucher
that might send the child to summer camp.
Parents who are well-informed and well-meaning will make good choices
for their children. However, many parents are not informed about health
care and a few, sadly, put their own needs ahead of their children's.
Poor choices will be made, and children will suffer. We hope you will
agree that any incentives built into the plan should reward those who
seek timely and appropriate health care.
Finally, we have concerns about the proposed discount drug card. Poor
children and pregnant women are the wrong populations for discount drug
cards. By allowing consumers who have used all of the funds in their
non-emergency accounts to receive drug discount cards to buy prescriptions
at participating pharmacies, the plan presents two problems. First,
families at or near 133% of poverty don't have the income even to buy
discounted drugs. Some will be unable to buy the medicine their children
need. Second, families in more-rural areas of New Hampshire may not
have access to the discounted medicine if the local pharmacy declines
to participate in the program.
Again, thank you for the opportunity to comment. We'd be happy to discuss
any of our concerns in more depth.
Sincerely,
Ellen Shemitz
President
Steve Varnum
Public Policy Director
Cc: Gov. John Lynch
Rep. Neal Kurk
Rep. Marshall Lee Quandt
Stephen Norton, DHHS
